When Tricia Salese called her local pharmacy for a price check on her next prescription refill, she was stunned when the pharmacist told her the cost of her generic-brand pain medication had gone up again.
Salese, 49, started talking fentanyl citrate, the generic version of Actiq, a powerful painkiller, in 2010, and she takes three doses per day. Back then, she said, the price per dose was 50 cents. Now, the pharmacist told her when she called, it was going to cost her $37.49 per dose.
“I thought $25 [per dose for generics] was a lot. $37 is just-- What is this stuff made of? I mean, this is ridiculous,” Salese said.
Salese takes fentanyl citrate to help her function with endometriosis, a chronic disease where the lining of the uterus grows outside of the womb and causes lesions that can worsen over time. The condition leaves her in constant, crippling pain and this medication is not covered by her insurance. So with the cost going up, Salese said she’s had to dip into her retirement savings to pay for her prescriptions.
“I realized if I wanted to keep my job and my life, I was going to have to find a way to pay for this,” she said. “I started taking money out of my IRA, and that’s how we had to pay for it.”
The staggering cost of some generic brand drugs has led patients and pharmacists across the country to ask questions about alarming price increases on certain drugs -- the once reliably low-cost copies of the more expensive branded products.
For example, Anthony Martincic, a pharmacist in New York City, said a tube of topical allergy cream used to treat rashes and other skin conditions used to cost a pharmacist around $5 a tube. But today, Martincic said, the cost is $205.51 a tube.
These costs are not increasing by 5 or 6 percent, but hundreds or even thousands of percent. In the span of one year, from 2012 to 2013, the cost of the generic blood pressure medication captopril jumped more than 2,700 percent, the asthma drug albuterol sulfate went up more than 3,400 percent and the antibiotic doxycycline jumped a whopping 6,300 percent, according to National Average Drug Acquisition Cost (NADAC) statistics.
“The prices are ridiculous and [my customers] are like, 'You know what? I can't afford this. I have to feed my children,' and they walk away,” said Aniedi Etuk, who has been a pharmacist for 12 years.
A survey released last month by The National Community Pharmacists showed that 80 percent of pharmacists saw an upswing in generic drug prices 26 or more times over the previous six months. And 93 percent said the situation has grown worse since 2013.
Brad Arthur, the president elect of NCPA, said the price spikes are unprecedented.
“Every month that goes by ... we see a half a dozen added to that list,” Arthur said. “And pharmacists’ hands are tied even as they are trying to help customers fill prescriptions below cost.”
In the past, when a branded drug lost its patent, generics entered the market and prices plummeted, saving the American health care system billions of dollars. Generics have served to help make drugs affordable, but now, Americans are asking why prices are trending the other way.
Jonathan Alpern is the chief resident of internal medicine at Regions Hospital in St. Paul, Minnesota, and was one of the co-authors of a New England Journal of Medicine article that helped bring the issue to light.
"One of the things that’s difficult with all of this is transparency," Alpern said. "So when the prices go up, it’s nice for providers and patients to know first of all -- what drugs are going up and why. It was really hard to find out that information... [and] I was initially shocked and when we started to see that this was happening to multiple other common drugs."
Hani Hamden, 36, said he had to break the law to afford the medication he needed. A dentist originally from Jordan, Hamden said he had to look overseas when doctors prescribed him a daily dose of albendazole for six months in 2013 to treat a parasite. The drug, which was $5.92 per dose in 2010, rang up in 2013 at $119 per dose.
Hamden turned to relatives abroad to help him find a cheaper version of the drug, and said it was surprisingly easy to find. Although it is illegal for consumers to import prescription drugs into the U.S., Hamden had his relatives ship him the cheaper drugs anyway.
“They found it for close to $100 for a three-month supply, just $100,” he said. “I’m pretty fortunate to have somebody who actually lives overseas that can send me the drug. I know most people don’t have that privilege.”
Albendazole is an example of an old drug priced high, critics say, because it only has one manufacturer.
Sen. Bernie Sanders, I-Vt., a Democratic presidential candidate, places the blame for rising costs on drug makers and the robust prescription drug lobby.
“The short answer is greed,” Sanders said. “They can do it. They can get away with it. They can make outrageous sums of profits and money on this and that’s what they’re doing.”
“Our job in Congress is to say to these drug companies, 'You can’t keep ripping off the American people,'” Sanders said. “'You can’t force folks to be in a situation where they can’t purchase the medicine they desperately need.' That’s what we should be doing.”
The U.S. is currently one of a few developed countries that doesn't negotiate prices with the pharmaceutical industry, Sanders said. Current federal law prohibits Medicare from negotiating lower prices with drug companies. Although Sanders's new proposal won’t give the federal government the power to do so, it will require generic drug makers to pay Medicaid a rebate any time prices rise above and beyond inflation. Brand name drug makers already do this.
Profit is no doubt a driving force in the recent price spike of generics. But experts say prices can also rise for other reasons, including raw material shortages, manufacturing disruptions because of factory closings or violations, or companies leaving the market or merging with competitors. All of those factors reduce supply and competition.
Drug companies argue that another factor is that the FDA has been slow to approve the thousands of generic drugs currently in its backlog.
Ralph G. Neas, the president and chief executive of the Generic Pharmaceutical Association, told ABC News' "Nightline" in a statement that “some short-term cost fluctuations may occur for individual products facing unique circumstances,” but that the generally lower cost of generic drugs brings value that is “consistent and irrefutable.”
There are signs that regulators are cracking down on rising prices. Last year, the U.S. Department of Justice issued grand jury subpoenas to three drug makers in relation to price spikes and, just last month, the Department of Health and Human Services also agreed to investigate price spikes.
In the meantime, Tricia Salese said she has now spent $80,000 on her medication and that she and her husband, Vincent Salese, are struggling to maintain their retirement funds. Vincent said he felt helpless watching his wife suffer.
"I want to fix her and I can't fix her, and not be able to help her just tears me apart," Vincent Salese said. “It’s taken a toll on our marriage, on our plans. We planned to sail around the world. That’s gone. That can’t happen now."
In a statement to "Nightline," Mallinckrodt, the drugmaker that makes the pain killer fentanyl citrate, said the pricing on that drug has remained "stable" since 2010 and that they don't comment "specifically on pricing matters."
Tricia Salese started a new job with a technology company. She is waiting to hear if her new insurance will cover her much-needed pain medication.
“I don’t know what else to do,” she said. “I’m hoping that my insurance will cover it. I’m praying, praying that my new insurance will cover it. ... And if it doesn’t, I keep fighting. I don’t know what else to do. I don’t even want to think about it.”